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Tuesday, July 04, 2017

Getting it right in the battle against opioid overdose deaths

According to the Centers for
Disease Control, Alabama, Tennessee and West Virginia – in that order – lead
the nation in prescriptions for narcotic painkillers. Nationwide, there were
close to 60,000 deaths in 2016 from drug overdoses.

How is this possible, when
narcotics are strictly controlled? A popular target for blame for this problem
is the pharmaceutical industry, which is often the focus of criticism. “We
would not have a drug problem if manufacturers weren’t trying so hard to sell
them,” the reasoning, such as it is, goes.

But making and selling drugs is what
drug manufacturers do: they spend millions or billions of dollars over a decade
and often longer to find the right formula to create a product that will help
people suffering from a medical condition. They work to get the product through
lengthy clinical trials and the stringent FDA approval process. Then, they must
sell enough of that product during the patent protection period to recoup the
costs of its development so the company can invest that money in another
product’s development.

Also understand that drug companies
do not provide addictive drugs to individuals, neither the legal users, nor the
illegal users. They provide them to distributors, or directly to pharmacies,
and unless someone steals them or distributes them improperly, they will
contribute not one bit to a drug problem.

Far too many prescription drugs do get
to users through “pill mills,” and some physicians who don’t have sufficient
information about the effects of some drugs as they need may, as a result, over-prescribe
them. And, obviously, these problems must be addressed.

However, a recent Daily Signal article
tells us that the painkiller abuse problem is not primarily caused by prescription
drug abuse and misuse, although the news we hear might convince many of us that
drug companies are at fault.

The article, written by former
director of the Office of National Drug Control Policy, Bill Bennett, who is
also a former U.S. Secretary of Education, and Robert L. DuPont, MD, president
of the Institute for Behavior and Health, explains that of the 60,000 deaths in
the U.S. in 2016 from drug overdoses, 33,000 of them were opioid related.

And, they add that our news media
mistakenly focus more attention on prescription drugs, instead of the illegal
ones. Is that because Big Pharma is an easy and popular target?

Bennett and DuPont, in fact, say,
“nearly 70 percent of our nation’s opioid deaths do not come via prescription
abuse.” “The main problem today, and the growth for tomorrow,” they say, “is
illegal opioids such as heroin, illegal fentanyl, and a hundred other
synthetics, not legal drugs used illegally or in ways not as prescribed.”

They cite data from the Obama administration’s
press office in 2015 saying that there were 33,091 opioid overdose deaths, 12,990
of which were from heroin. Another 9,580 were from synthetic opioids, mostly
illegal fentanyl.

They propose a two-phased attack on
the problem. First, fight harder against illegal drugs coming into the U.S.
through better border enforcement to stop the drug traffic from and through Mexico,
as well as working to have Mexico eliminate its poppy crops; have stricter
monitoring of international mail services; and crack down on cartel activity, both
here in the U.S. and at their source.

The second phase acknowledges that
most money directed at the problem goes to “treatment, recovery, and urgent
overdose reversal,” which they say is certainly important, but it is not
enough. “We need to improve engagement in treatment, reduce dropout, and
address the far too common outcome of relapse with sustained recovery—meaning
no use of alcohol, marijuana, or other drugs,” by recovering addicts.

“But the main unaddressed nature of
the opioid crisis,” Bennett and DuPont say, “is focus and energy on prevention.”
This includes serious efforts to educate the public about what is in their
medicine cabinets and how to keep those drugs out of the hands of those for
whom they aren’t prescribed, and to educate the public about the dangerous
nature of the drugs sold on the street. It is critical to also work to
counteract the youthful use of alcohol, marijuana, tobacco and other drugs,
where they say 90 percent of addictions begin.

Citing the rising death toll from
illegal drugs, which they note is much greater than the crack cocaine problem
in the 80s, the authors call for more effective action by political leaders,
parents, the entertainment industry and health care professionals.

Looking back to the late 1970s and
1980s Bennett and DuPont recount how the nation conquered the serious drug
problems of that time. “The nation rolled up its sleeves, went to work, talked
about it, taught about it, and reversed it—and by 1992 we had cut drug use in
half, and even more in some age groups.”

This problem is entirely
preventable, and certainly can be dramatically reduced. “In sum, let us
commence a strategy to stop the problems of abuse before they start,” they
wrote. “It will take a nationwide effort, from the president’s bully pulpit down
to local community messaging.”

Certainly, focusing on the real
problem will produce positive results.